Early Outcomes of Tendon Repair and Reconstruction in the Hand using Barbed Sutures

1. Early Outcomes of Tendon Repair and
Reconstruction in the Hand using Barbed
Sutures
Daniel Hap, R Vaikunthan
Department of Orthopaedic Surgery
Khoo Teck Puat Hospital

2. Introduction
 Tendon repair and reconstruction an integral part of Hand
Surgery
 Advancements in suture material, suture techniques1
 Conventional sutures pose problems of 2
 Knot rupture, unravelling
 Bulky knot material  inhibit tendon gliding
 Barbed sutures may be the solution
 Knotless
1Thurman RT, Trumble TE, Hanel DP, Tencer AF, Kiser PK. Two-,four-, and six-strand zone II flexor tendon repairs:
an in situ biomechanical comparison using a cadaver model. J Hand Surg. 1998;23: 261–5.
2 A Shah, M Rowlands. Barbed Sutures and Tendon Repair—a Review; HAND (2015) 10:6–15

3. Objectives
 To examine the early outcomes of tendon repair and
reconstruction in the hand using barbed sutures
 Identify potential complications

4. Methods
 Retrospective study
 Conducted in KTPH from August 2015 to July 2016
 ‘OT Sys’ used as search tool
 All patients who underwent tendon repair and reconstruction
of the hand using barbed sutures included
 Case-notes reviewed for
 Patient demographics
 Diagnosis
 Surgery performed
 Surgical technique
 Type of suture used

5. Methods
 Clinic notes and records from Hand Occupational Therapist
reviewed
 Range of motion
 Complications
 Revision surgery

6. Results
 16 patients underwent repair or reconstruction of tendon of hand
using barbed sutures.
 1 patient with repaired EPL laceration lost to follow-up
 15 patients with of 18 operated hand tendons
• 3 patients with concomitant injuries to 2 tendons on the same hand
 9 females and 6 males
 Age ranged from 23 to 80 years old,
 Follow-up duration ranged from 3 to 8 months

7. Results – Surgical technique
 All repairs performed using V-LOC 3-0 non-absorbable sutures
 Standard tendon repair techniques employed
 Post-op care: Standard flexor / extensor tendon repair protocol
by Hand OT.

8. Results
7
8
3
Tendon repair / reconstruction
Tendon transfer
Flexor tendon
repair
Extensor tendon
repair

9. Results – Nature of surgery
Pt
No.
Surgery Type Complications
Adhesions Rupture
1 Trapeziectomy and APL
suspensioplasty
Tendon transfer Nil Nil
2 PL to APB Camitz Transfer Tendon Transfer Nil Nil
3 FDS repair (MF) Flexor repair Nil Nil
FDP repair (MF) Flexor repair Nil Nil
4 EPL repair Extensor repair Nil Nil
5 Trapeziectomy and APL
suspensioplasty
Tendon transfer Nil Nil
6 PL to APB Camitz Transfer Tendon transfer Nil Nil
7 APB to EPL graft Tendon transfer Nil Nil
8 Trapeziectomy and APL
suspensioplasty
Tendon transfer Nil Nil

10. Results – Nature of surgery
Pt
No.
Surgery Type Complications
Adhesions Rupture
9 FPL repair Flexor repair Nil Nil
10 FDP repair (MF) Flexor repair Nil Nil
FDP repair (LF) Flexor repair Nil Nil
11 EIP to EPL tendon graft Tendon transfer
12 EPL repair Extensor repair Nil Nil
13 EPL repair Extensor repair Nil Nil
14 FDP repair Flexor repair Nil Nil
15 FDP repair (LF) Flexor repair Nil Nil
FDS repair (LF) Flexor repair Nil Nil

11. Results – Pt #10
LF FDP rupture LF FDP Post-repair
MF FDP rupture MF FDP post-repair

12. Results

13. Results

14. Discussion
 Barbed suture repair described since 1960s1
 Advantages:
1. Barbs provide multiple anchoring points, uniform
distribution of tissue-holding forces
2. Knotless suturing
1 McKenzie AR. An experimental multiple barbed suture for the long flexor tendons of the palm and fingers. Preliminary report. J
Bone Joint Surg 1967;49B:440–447.
Source:
http://mms.businesswire.com/bwapps/mediaserv
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15. Discussion
 24 studies identified in MEDLINE, EMBASE, Google Scholar
 2 meta-analysis, 21 biomechanical studies, 1 in-vivo study (chickens)
 No in-vivo study with human subjects.

16. Discussion
 Studies showing biomechanically comparable, if not superior
results in barbed sutures.
 Greater or equivalent load to failure1,2
 Smaller cross-sectional area3
 Friction between exposed barbs and flexor tendon sheath4.
 Adhesions
1 Joyce CW, Whately KE, Chan JC, Murphy M, O’Brien FJ, Carroll SM. Flexor tendon repair: a comparative study between a
knotless barbed suture repair and a traditional four-strand monofilament suture repair. J Hand Surg Eur Vol. 2014;39:40–5
2 Parikh PM, Davison SP, Higgins JP. Barbed suture tenorrhaphy: an ex vivo biomechanical analysis. Plast Reconstr Surg.
2009;124: 1551–8.
3 McClellan WT, Schessler MJ, Ruch DS, Levin LS, Goldner RD. A knotless flexor tendon repair technique using a bidirectional
barbed suture: an ex vivo comparison of three methods. Plast Reconstr Surg. 2011;128:322e–7e
4 Oded BA, J Kargel, B Mailey. The Effect of Barbed Suture Tendon Repair on Work of Flexion. J Hand Surg Am.
2015;40(5):969-974

17. Limitations
 Retrospective study
 Small sample size
 No comparison between barbed suture and traditional
sutures in our study

18. Conclusion
 Early outcomes of using barbed sutures for tendon repair
and reconstruction in the hand favourable.
 Viable alternative to traditional sutures
 Advantages – less suture material and faster repair.
 Further studies required to ascertain long term results
 Prospective study to compare barbed sutures and
traditional sutures.

19. THANK YOU